GLP-1 receptor agonist utilization and survival outcomes in a large U.S. community oncology cohort.

Abstract

11017 Background: GLP1 use has increased with 12.4% of U.S. adults reported using these treatments, driven in part by the 2021 approval of semaglutide for chronic weight management without diabetes. Beyond established metabolic benefits, emerging preclinical and observational data suggest potential anticancer effects of GLP1 therapy. However, no study to date has characterized GLP1 use among cancer patients treated in a large-scale population. This study provides an essential step towards describing real-world world GLP1 treatment patterns and clinical outcomes. Methods: Structured EHR data from The US Oncology Network were used to identify GLP1 users (dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, and tirzepatide) and nonusers between January 2021 and October 2024, with follow-up through October 2025. Overall survival (OS) was assessed from initial cancer diagnosis to death from any cause. Nonusers were matched to GLP1 users by cancer type and diagnosis year. To address immortal time bias, each nonuser was assigned the matched user’s GLP1 medication start date as the anchor date; nonusers who died or were lost to follow-up prior to that date were excluded. Multivariable Cox proportional hazards models evaluated factors associated with OS among patients diagnosed with breast, prostate, lung, hepatocellular, or renal cancer. Results: A total of 1,121 GLP1 users and 471,580 non GLP1 users with cancer were identified. GLP1 users had a median age of 63 years, were 63% White, and 69% had BMI ≥30 kg/m 2 semaglutide was the most commonly used agent (64%). Non GLP1 users had a median age of 68 years, were 61% White, and 30% had BMI ≥30 kg/m 2 . Among GLP1 users, 74% were prescribed GLP1 therapy after initial cancer diagnosis, of those 7% after metastatic diagnosis; the most common cancers were breast (27%) and prostate (13%). OS at 24 months was higher among GLP1 users versus nonusers for both breast cancer (97.9% [95% CI 93.7–99.3] vs 92.6% [92.4–92.8]) and prostate cancer (97.9% [93.7–99.3] vs 92.6% [92.4–92.8]). After adjustment for age, BMI, stage, and cancer type, GLP1 use was significantly associated with improved OS (HR 0.58, 95% CI 0.40–0.84; p = 0.0036). Conclusions: In this large real-world cohort, GLP1 use was most frequently observed among younger patients with obesity and was commonly prescribed after cancer diagnosis, with semaglutide accounting for the majority of prescriptions. Breast and prostate cancers were the most prevalent malignancies among GLP1 users, reflecting early adoption across common solid tumor types in routine practice. Despite limitations inherent to structured real-world data, including potential underreporting of GLP1 exposure, GLP1 use was associated with improved OS compared with nonuse, supporting the need for future studies using robust causal inference approaches.